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Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial

BMJ 2009; 339 doi: (Published 30 October 2009) Cite this as: BMJ 2009;339:b4080
  1. Inge M Custers, PhD student and registrar1,
  2. Paul A Flierman, fertility doctor2,
  3. Pettie Maas, fertility doctor3,
  4. Tessa Cox, fertility doctor4,
  5. Thierry J H M Van Dessel, gynaecologist5,
  6. Mariette H Gerards, fertility doctor6,
  7. Monique H Mochtar, gynaecologist1,
  8. Catharina A H Janssen, gynaecologist7,
  9. Fulco van der Veen, professor of gynaecology and fertility specialist1,
  10. Ben Willem J Mol, professor of gynaecology13
  1. 1Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
  2. 2Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam
  3. 3Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
  4. 4Department of Obstetrics and Gynaecology, Antonius Ziekenhuis, Nieuwegein, Netherlands
  5. 5Department of Obstetrics and Gynaecology, TweeSteden Ziekenhuis, Tilburg, Netherlands
  6. 6Department of Obstetrics and Gynaecology, Martini Ziekenhuis, Groningen, Netherlands
  7. 7Department of Obstetrics and Gynaecology, Groene Hart Ziekenhuis, Gouda, Netherlands
  1. Correspondence to: I Custers i.m.custers{at}
  • Accepted 31 August 2009


Objective To evaluate the effectiveness of 15 minutes of immobilisation versus immediate mobilisation after intrauterine insemination.

Design Randomised controlled trial.

Setting One academic teaching hospital and six non-academic teaching hospitals.

Participants Women having intrauterine insemination for unexplained, cervical factor, or male subfertility.

Interventions 15 minutes of immobilisation or immediate mobilisation after insemination.

Main outcome measure Ongoing pregnancy per couple.

Results 391 couples were randomised; 199 couples were allocated to 15 minutes of immobilisation after intrauterine insemination, and 192 couples were allocated to immediate mobilisation (control). The ongoing pregnancy rate per couple was significantly higher in the immobilisation group than in the control group: 27% (n=54) versus 18% (34); relative risk 1.5, 95% confidence interval 1.1 to 2.2 (crude difference in ongoing pregnancy rates: 9.4%, 1.2% to 17%). Live birth rates were 27% (53) in the immobilisation group and 17% (32) in the control group: relative risk 1.6, 1.1 to 2.4 (crude difference for live birth rates: 10%, 1.8% to 18%). In the immobilisation group, the ongoing pregnancy rates in the first, second, and third treatment cycles were 10%, 10%, and 7%. The corresponding rates in the mobilisation group were 7%, 5%, and 5%.

Conclusion In treatment with intrauterine insemination, 15 minutes’ immobilisation after insemination is an effective modification. Immobilisation for 15 minutes should be offered to all women treated with intrauterine insemination.

Trial registration Current Controlled Trials ISRCTN53294431.


  • This work was presented as an oral presentation at the 24th Annual Meeting of the European Society of Human Reproduction and Embryology 2008, in Barcelona, Spain.

  • Contributors: BWJM and FvdV designed the study. IMC promoted it, coordinated this randomised controlled trial, collected the data, and sought ethical approval. PAF, PM, TC, HJHMVD, MHG, MHM, and CAHJ included couples and collected data. IMC did the analysis, under the supervision of BWJM. All authors helped to prepare the final report. IMC, BWJM, and PvdV are the guarantors.

  • Funding: None.

  • Competing interests: None declared.

  • Ethical approval: The institutional review board of the Academic Medical Centre, Amsterdam, approved study protocol. Local permission was obtained in each of the seven participating hospitals. All participants gave written informed consent.

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